Presence of edema guides treatment of Fuchs' dystrophy and cataract
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KOLOA, Hawaii — In a patient with Fuchs’ dystrophy and cataract, PK is the cornea technique of the past and endothelial keratoplasty is the technique for the present, Marian S. Macsai, MD, said at Hawaiian Eye 2020.
First, though, the surgeon must decide whether a corneal procedure is needed at the time of cataract surgery.
“Where there isn’t frank corneal edema, those are the patients who are most challenging for all of us,” Macsai said.
Using Scheimpflug tomography to identify edema and classify Fuchs’ endothelial corneal dystrophy can guide treatment, she said.
“Talk to the patient, look at the slit lamp, check the data, check your pachymetry, but ideally, look at the tomography,” she said.
Corneas with clinically definite edema need cataract extraction and endothelial keratoplasty; corneas with subclinical edema need cataract extraction and endothelial keratoplasty; and patients with no edema and no topographic changes can get by with cataract extraction only, she said.
“If you’re only doing cataract surgery, warn the patient about edema, because Descemet’s membrane endothelial keratoplasty or Descemet’s stripping only may be in the future for these patients,” she said. – by Patricia Nale, ELS
Reference: Macsai MS. Cornea and cataract. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosure: Macsai reports she is a consultant or speaker for Abbvie, Aerie, Allergan, Avedro, Bruder, Dompè, PRN and Trefoil.